Mother-to-Child Transmission of HIV: Development of Infant Drug Resistance

In September of 2000, the General Assembly of the United Nations held the Millennium Summit to adopt an “Earth Charter” and a “Declaration” that would lead to global governance.  The summit focused on the role of the United Nations in the 21st century; in particular, the UN’s role in pulling over one billion people out of extreme poverty, halting the pandemic of HIV/AIDS and protecting the global environment.  With 150 heads of state in attendance, it was the largest gathering of world leaders in history as of 2000; the outcome of this summit was eight international development objectives known as the UN Millennium Goals.  Two of these goals expressed an intention by the year 2015 to reverse the spread of HIV/AIDS1 and to reduce by 66% the infant mortality rate 2.

Using a class of pharmaceutical drugs known as anti-retrovirals (ARVs), great strides have been made toward achieving these UN Millennium Goals.  However, each year approximately 300,000 infants still contract HIV/AIDS 3.  Almost all of these HIV+ infants are infected through mother-to-child transmission, and in the absence of treatment,  half will die before the age of two.  Using ARV therapy, the total rate of mother-to-child transmission (MTCT) can be reduced to between two and five percent (without treatment, rates are between 20-45%) 4.   In developed countries where ARVs are readily available and can be easily accessed by HIV+ pregnant women, this therapy is an effective tool in protecting infants.  However, in resource poor countries, where 70% of the HIV+ population exist, ARV therapy is not always available; when it is, patient compliance cannot be guaranteed because of associated HIV stigma, and often, HIV+ pregnant women cannot access the medication.  Consequently, of the 300,000 HIV infected infants yearly, 250,000 occur in the ten countries with the highest number of HIV+ pregnant women 4.

In addition to the challenges of ARV availability, distribution and patient compliance, the issue of ARV (drug) resistance is a growing issue.which is seldomly discussed.  It turns out that when ARVs are administered to HIV+ pregnant women in accordance with WHO recommendations, more than half the infants who still contract HIV demonstrate resistance to further treatment with ARVs 5.  Sadly, the progression of HIV/AIDS in infants is much more rapid than the progression of HIV in adults.  Infant CD4 counts drop more quickly, they present with AIDS symptoms sooner and usually die within 24 months of birth.

At present, the best treatment in the prevention of mother-to-child transmission (PMTCT) is anti-retroviral therapy.  While ARV therapy goes a long way towards meeting the UN Millennium Goals of reversing the spread of HIV/AIDS and of reducing the infant mortality rate, it cannot be the final answer for PMTCT.  The hurdles of availability, distribution, patient compliance, and drug resistance make if far from an optimal solution to the problem.  The scientific community must continue to look at alternative solutions for HIV MTCT such as Vitalwave™, a photodisinfection technology currently under development 6.

1 UN Millennium Goal 6A –

2 UN Millennium Goal 4A –

3 Towards Universal Access: Scaling up priority HIV/AIDS Interventions in the Health Sector, 2010 Progress Report –
4 PMTCT Strategic Vision 2010-2015 –
5 Antiretroviral Drugs for Treating Pregnant Women and Preventing HIV Infection in Infants –


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